Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1995 Jan;77(1):16–20.

Surgical management of the septic complications of diverticular disease.

A L Khan 1, A K Ah-See 1, T J Crofts 1, S D Heys 1, O Eremin 1
PMCID: PMC2502524  PMID: 7717637

Abstract

This retrospective study has reviewed the surgical management of the septic complications of diverticular disease involving the left colon in 77 patients who presented between 1980 and 1992. Over this period, Hartmann's resection continued to be the predominant surgical procedure. The overall mortality and morbidity rates in the study period were 10% and 31%, respectively. However, a marked improvement in survival was recorded in the latter half of the study (17% vs 6%). The mortality from Hartmann's resection was also reduced substantially in the second half of the study (24% vs 7.5%). These improvements occurred despite having a higher number of poor-risk patients (APACHE II score) with more severe pathology (generalised peritonitis, 35% vs 50%; faecal peritonitis, 9% vs 25%) in the latter half. There was a significantly worse survival in patients who were over 70 years of age (P < 0.03), those who had a severe concomitant medical illness (P < 0.02), those who had a generalised peritonitis (P < 0.02), and in those patients who had an APACHE II score of over 11 (P < 0.05) (Fisher's exact test). There was no difference in outcome (morbidity, mortality) between the various grades of surgeon involved in performing the emergency surgical procedures.

Full text

PDF
16

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BELDING H. H., 3rd Acute perforated diverticulitis of the sigmoid colon with generalized peritonitis. AMA Arch Surg. 1957 Apr;74(4):511–515. doi: 10.1001/archsurg.1957.01280100029004. [DOI] [PubMed] [Google Scholar]
  2. Bakker F. C., Hoitsma H. F., Den Otter G. The Hartmann procedure. Br J Surg. 1982 Oct;69(10):580–582. doi: 10.1002/bjs.1800691007. [DOI] [PubMed] [Google Scholar]
  3. Bell G. A., Panton O. N. Hartmann resection for perforated sigmoid diverticulitis. A retrospective study of the Vancouver General Hospital experience. Dis Colon Rectum. 1984 Apr;27(4):253–256. [PubMed] [Google Scholar]
  4. Berry A. R., Turner W. H., Mortensen N. J., Kettlewell M. G. Emergency surgery for complicated diverticular disease. A five-year experience. Dis Colon Rectum. 1989 Oct;32(10):849–854. doi: 10.1007/BF02554554. [DOI] [PubMed] [Google Scholar]
  5. Botsford T. W., Zollinger R. M., Jr, Hicks R. Mortality of the surgical treatment of diverticulitis. Am J Surg. 1971 Jun;121(6):702–705. doi: 10.1016/0002-9610(71)90050-x. [DOI] [PubMed] [Google Scholar]
  6. Classen J. N., Bonardi R., O'Mara C. S., Finney D. C., Sterioff S. Surgical treatment of acute diverticulitis by staged procedures. Ann Surg. 1976 Nov;184(5):582–586. doi: 10.1097/00000658-197611000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Howe H. J., Casali R. E., Westbrook K. C., Thompson B. W., Read R. C. Acute perforations of the sigmoid colon secondary to diverticulitis. Am J Surg. 1979 Feb;137(2):184–187. doi: 10.1016/0002-9610(79)90141-7. [DOI] [PubMed] [Google Scholar]
  8. Hulkko O. A., Laitinen S. T., Haukipuro K. A., Ståhlberg M. J., Juvonen T. S., Kairaluoma M. I. The Hartmann procedure for the treatment of colorectal emergencies. Acta Chir Scand. 1986 Aug-Sep;152:531–535. [PubMed] [Google Scholar]
  9. Killingback M. Management of perforative diverticulitis. Surg Clin North Am. 1983 Feb;63(1):97–115. doi: 10.1016/s0039-6109(16)42932-4. [DOI] [PubMed] [Google Scholar]
  10. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  11. Kronborg O. Treatment of perforated sigmoid diverticulitis: a prospective randomized trial. Br J Surg. 1993 Apr;80(4):505–507. doi: 10.1002/bjs.1800800434. [DOI] [PubMed] [Google Scholar]
  12. Krukowski Z. H., Matheson N. A. Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. Br J Surg. 1984 Dec;71(12):921–927. doi: 10.1002/bjs.1800711202. [DOI] [PubMed] [Google Scholar]
  13. LARGE J. M. TREATMENT OF PERFORATED DIVERTICULITIS. Lancet. 1964 Feb 22;1(7330):413–414. doi: 10.1016/s0140-6736(64)92790-4. [DOI] [PubMed] [Google Scholar]
  14. Levison M. A., Zeigler D. Correlation of APACHE II score, drainage technique and outcome in postoperative intra-abdominal abscess. Surg Gynecol Obstet. 1991 Feb;172(2):89–94. [PubMed] [Google Scholar]
  15. MADDEN J. L., TAN P. Y. Primary resection and anastomosis in the treatment of perforated lesions of the colon, with abscess or diffusing peritonitis. Surg Gynecol Obstet. 1961 Nov;113:646–650. [PubMed] [Google Scholar]
  16. Medina V. A., Papanicolaou G. K., Tadros R. R., Fielding L. P. Acute perforated diverticulitis: primary resection and anastomosis? Conn Med. 1991 May;55(5):258–261. [PubMed] [Google Scholar]
  17. Peoples J. B., Vilk D. R., Maguire J. P., Elliott D. W. Reassessment of primary resection of the perforated segment for severe colonic diverticulitis. Am J Surg. 1990 Mar;159(3):291–294. doi: 10.1016/s0002-9610(05)81220-6. [DOI] [PubMed] [Google Scholar]
  18. RYAN P. Emergency resection and anastomosis for perforated sigmoid diverticulitis. Br J Surg. 1958 May;45(194):611–616. doi: 10.1002/bjs.18004519409. [DOI] [PubMed] [Google Scholar]
  19. Smithwick R. H. EXPERIENCES WITH THE SURGICAL MANAGEMENT OF DIVERTICULITIS OF THE SIGMOID. Ann Surg. 1942 Jun;115(6):969–985. doi: 10.1097/00000658-194206000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Underwood J. W., Marks C. G. The septic complications of sigmoid diverticular disease. Br J Surg. 1984 Mar;71(3):209–211. doi: 10.1002/bjs.1800710314. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES